Management of Missed Progestin-Only Pills

Missed POP Management Protocol

• If a progestin-only pill (POP) is missed by more than 3 hours, the Centers for Disease Control and Prevention recommends taking the missed pill immediately, continuing daily pills, using backup contraception for 2 consecutive days, and considering emergency contraception if unprotected intercourse occurred 1, 2
• A POP is considered missed if taken more than 3 hours after the scheduled time, according to the Centers for Disease Control and Prevention 1, 3

Vomiting or Severe Diarrhea Management

• If vomiting or severe diarrhea occurs within 3 hours after taking a POP, the Centers for Disease Control and Prevention recommends taking another pill as soon as possible and continuing taking pills daily at the same time 1, 5

Bridging with Other Contraception

• The American Academy of Family Physicians suggests that the copper IUD is the most effective emergency contraception option 4
• The American Academy of Family Physicians recommends ulipristal acetate (Ella) as a more effective emergency contraception option than levonorgestrel after the first 72 hours 4

Important Considerations

• The Centers for Disease Control and Prevention notes that POPs inhibit ovulation in only about half of cycles 1
• The Centers for Disease Control and Prevention states that an estimated 48 hours of POP use is necessary to achieve contraceptive effects on cervical mucus 1

Common Pitfalls to Avoid

• The Centers for Disease Control and Prevention warns that taking POPs at inconsistent times is a major reason for contraceptive failure 1
• The Centers for Disease Control and Prevention advises that not using backup contraception after missed pills significantly increases pregnancy risk 1

Follow-Up Recommendations

• The Centers for Disease Control and Prevention recommends no routine follow-up visit after initiating POPs, but return at any time to discuss side effects, problems, or to change methods 1, 6